title: Surgeon-specific performance reports in general surgery: an observational study of initial implementation and adoption.
abstract: BACKGROUND
  As national quality initiatives are increasing requirements for individual physician data, our department of surgery initiated a surgeon-specific reporting (SSR) program to assess the value of personal knowledge on individual performance quality. We sought to evaluate the use of SSR as a tool to enable surgeons to assess and improve their clinical performance, and to identify barriers to use of their reports.
  
  
  METHODS
  Qualitative research design involving semistructured interviews of surgeons who received performance reports derived from National Surgical Quality Improvement Program (NSQIP), Surgical Care Improvement Project (SCIP), and the Centers for Medicare and Medicaid Services (CMS) core measures and hospital administrative data. Transcripts were analyzed by the constant comparative method.
  
  
  RESULTS
  Twenty-four of 39 surgeons (61.5%) who received their SSRs agreed to be interviewed and 23 were interviewed. About half (11 of 23) demonstrated comprehension of the data validity, accuracy, or complexity. Of these, 6 took steps to validate data or improve performance. Most respondents believed SSR would lead to performance improvement through knowledge of personal outcomes and peer comparison; however, they perceived SSR had limitations, such as small sample size and potential coding errors, and could lead to unintended consequences, such as inaccurate interpretation by others and surgeons' aversion to selecting high-risk patients. Respondents also suggested logistical improvements to reporting methods, such as report format and definitions of metrics.
  
  
  CONCLUSIONS
  Surgeon-specific reporting has the potential to empower surgeons to improve their practice; however, more surgeons need efficient guidelines to understand the metrics. Our findings can be used to guide development of more SSR programs. Whether SSR programs lead to improvements in surgical outcomes is a matter for future research.
authors.affiliation: Department of Surgery, The Methodist Hospital, Houston, TX. Electronic address: sgyi@tmhs.org.
authors.forename: Stephanie G
authors.initials: SG
authors.lastname: Yi
authors.forename: Nelda P
authors.initials: NP
authors.lastname: Wray
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Jones
authors.forename: Barbara L
authors.initials: BL
authors.lastname: Bass
authors.forename: Jeanne
authors.initials: J
authors.lastname: Nishioka
authors.forename: Sarah
authors.initials: S
authors.lastname: Brann
authors.forename: Carol M
authors.initials: CM
authors.lastname: Ashton
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D013502:General Surgery; D006801:Humans; D017063:Outcome Assessment, Health Care; D010818:Practice Patterns, Physicians'; D011785:Quality Assurance, Health Care; D019984:Quality Indicators, Health Care; D015203:Reproducibility of Results
keywords: ACS; American College of Surgeons; CABG; CMS; Centers for Medicare and Medicaid Services; NSQIP; National Surgical Quality Improvement Program; PAR; SCIP; SSR; Surgical Care Improvement Project; coronary artery bypass graft; physician activity report; surgeon-specific report